Crystallization of cholesterol may be what causes atherosclerotic plaque rupture, the trigger for heart attacks
Cholesterol Crystals May Tear Through Our Artery Lining
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In my video Arterial Acne, I described atherosclerotic plaques as inflamed pockets of pus. Our coronary arteries start out healthy as kids, but then the standard American diet, the saturated fat, trans fat, and cholesterol increase the cholesterol in our blood, which accumulates in the artery wall, triggering an inflammatory response. The fatty streak becomes an atherosclerotic plaque, which can then rupture into our artery. A blood clot forms, shutting off blood flow to a part of our heart, which can then die and kill us.
What causes that final step, the rupture of the plaque? Ten years ago, researchers at Michigan State proposed a mechanism. They noted that when you look at ruptured plaques from human autopsies of people who died from heart attacks, they were filled with cholesterol crystals protruding out from the plaque, so they wondered if maybe all that cholesterol in the plaque gets so supersaturated that it reaches a point that it crystallizes like sugar water forming rock candy. The growing crystals may then burst the plaque open. So they made a supersaturated solution of cholesterol in a test tube to see if when it crystallized it would expand, and indeed it did–just like how water expands when it crystallizes into ice. Here’s a cholesterol crystal shooting out the top of a test tube, and when you look at the tips of the cholesterol crystals under a microscope they are sharp jagged needles. They placed a thin membrane over the top of the test tube to see if the cholesterol needles would poke through, and indeed the sharp tips of the cholesterol crystals cut through the membrane. So they showed that as cholesterol crystallized, the peak volume can increase rapidly by up to 45% within minutes and sharp-tipped crystals can cut through and tear membranes, suggesting that the crystallization of supersaturated cholesterol in atherosclerotic plaques can induce the rupture that kills us.
A test tube is one thing, but can you actually see crystals poking out in autopsy specimens? Yes, cholesterol crystals piercing the arterial plaque were found in patients who died with heart attacks–acute coronary syndrome. Extensive protrusion of cholesterol crystals into the middle of the artery. What makes us think it was the crystals that actually burst the plaque?
All patients who died of acute heart attacks had perforating cholesterol crystals like this sticking out of their plaques, but no crystals were found perforating the arteries of people who had severe atherosclerosis, but died first of other, non-cardiac causes. This can explain why dramatically lowering cholesterol levels with diet or drugs can reduce the risk of fatal heart attack, by pulling cholesterol out of the artery wall, and decreasing the risk of crystallizing these cholesterol needles that may pop your plaque.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.
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- P Libby. Atherosclerosis: the new view. Sci Am. 2002 May;286(5):46-55.
- G S Abela. Cholesterol crystals piercing the arterial plaque and intima trigger local and systemic inflammation. J Clin Lipidol. 2010 May-Jun;4(3):156-64.
- G S Abela, K Aziz. Cholesterol crystals cause mechanical damage to biological membranes: a proposed mechanism of plaque rupture and erosion leading to arterial thrombosis. Clin Cardiol. 2005 Sep;28(9):413-20.
- G S Abela, K Aziz, A Vedre, D R Pathak, J D Talbott, J Dejong. Effect of cholesterol crystals on plaques and intima in arteries of patients with acute coronary and cerebrovascular syndromes. Am J Cardiol. 2009 Apr 1;103(7):959-68.
- C B Esselstyn Jr, G Gendy, J Doyle, M Golubic, M Foizen. A way to reverse CAD? J Fam Pract. 2014 Jul;63(7):356-364b.
In my video Arterial Acne, I described atherosclerotic plaques as inflamed pockets of pus. Our coronary arteries start out healthy as kids, but then the standard American diet, the saturated fat, trans fat, and cholesterol increase the cholesterol in our blood, which accumulates in the artery wall, triggering an inflammatory response. The fatty streak becomes an atherosclerotic plaque, which can then rupture into our artery. A blood clot forms, shutting off blood flow to a part of our heart, which can then die and kill us.
What causes that final step, the rupture of the plaque? Ten years ago, researchers at Michigan State proposed a mechanism. They noted that when you look at ruptured plaques from human autopsies of people who died from heart attacks, they were filled with cholesterol crystals protruding out from the plaque, so they wondered if maybe all that cholesterol in the plaque gets so supersaturated that it reaches a point that it crystallizes like sugar water forming rock candy. The growing crystals may then burst the plaque open. So they made a supersaturated solution of cholesterol in a test tube to see if when it crystallized it would expand, and indeed it did–just like how water expands when it crystallizes into ice. Here’s a cholesterol crystal shooting out the top of a test tube, and when you look at the tips of the cholesterol crystals under a microscope they are sharp jagged needles. They placed a thin membrane over the top of the test tube to see if the cholesterol needles would poke through, and indeed the sharp tips of the cholesterol crystals cut through the membrane. So they showed that as cholesterol crystallized, the peak volume can increase rapidly by up to 45% within minutes and sharp-tipped crystals can cut through and tear membranes, suggesting that the crystallization of supersaturated cholesterol in atherosclerotic plaques can induce the rupture that kills us.
A test tube is one thing, but can you actually see crystals poking out in autopsy specimens? Yes, cholesterol crystals piercing the arterial plaque were found in patients who died with heart attacks–acute coronary syndrome. Extensive protrusion of cholesterol crystals into the middle of the artery. What makes us think it was the crystals that actually burst the plaque?
All patients who died of acute heart attacks had perforating cholesterol crystals like this sticking out of their plaques, but no crystals were found perforating the arteries of people who had severe atherosclerosis, but died first of other, non-cardiac causes. This can explain why dramatically lowering cholesterol levels with diet or drugs can reduce the risk of fatal heart attack, by pulling cholesterol out of the artery wall, and decreasing the risk of crystallizing these cholesterol needles that may pop your plaque.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.
Please consider volunteering to help out on the site.
- P Libby. Atherosclerosis: the new view. Sci Am. 2002 May;286(5):46-55.
- G S Abela. Cholesterol crystals piercing the arterial plaque and intima trigger local and systemic inflammation. J Clin Lipidol. 2010 May-Jun;4(3):156-64.
- G S Abela, K Aziz. Cholesterol crystals cause mechanical damage to biological membranes: a proposed mechanism of plaque rupture and erosion leading to arterial thrombosis. Clin Cardiol. 2005 Sep;28(9):413-20.
- G S Abela, K Aziz, A Vedre, D R Pathak, J D Talbott, J Dejong. Effect of cholesterol crystals on plaques and intima in arteries of patients with acute coronary and cerebrovascular syndromes. Am J Cardiol. 2009 Apr 1;103(7):959-68.
- C B Esselstyn Jr, G Gendy, J Doyle, M Golubic, M Foizen. A way to reverse CAD? J Fam Pract. 2014 Jul;63(7):356-364b.
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Title
Cholesterol Crystals May Tear Through Our Artery Lining
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
Isn’t that extraordinary? Makes you really not want to be building up cholesterol in your arteries. I have a feeling, given the powerful visual, that this might be a good one to share with those in your life with heart disease, in hopes that they might reconsider eating artery-clogging diets.
Arterial Acne is video I mentioned on inflamed pockets of pus. Blocking the First Step of Heart Disease involves keeping our LDL cholesterol low by decreasing our intake of Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero. Switching from red meat to white won’t do it: Switching From Beef to Chicken and Fish May Not Lower Cholesterol
Does it matter if LDL cholesterol in our blood is small and dense or large and fluffy? See Does Cholesterol Size Matter?
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